bursitis

People often wonder, if I go to physical therapy will it hurt? Sometimes I’ve heard people say “PT” stands for “pain and torture.”

So, does physical therapy hurt? This is the good news: most of the time the answer is NO!

When will physical therapy hurt? Once in a while the answer is yes, BUT that is because of the surgery you have had and the steps that you need to go through to get past the normal side effects of having a surgery. What surgeries will be more painful to rehabilitate from? In my experience as a physical therapist, new knee replacements seem to be the most painful. Second to that is shoulder surgery. The worse pain is usually there for a while only then gets better as you recover and move more, usually within a few weeks to a month.

When should physical therapy be comfortable? Most of the time physical therapy should be comfortable and make you feel better as each treatment progresses. The old adage of “no pain no gain” does NOT apply. When you have an injury, working weak muscles until they are tired will be a good limit of exercise; if you push past the muscle you are working feeling tired (heavy and achey) you might cause more pain because your body is working in its weak zone and that is when more pain happens.

Will there be soreness after my physical therapy session? It is pretty common for patients to feel sore after their PT appointment, especially your first visit because we have to have you move a lot to fully evaluate your problem. Sometimes after introducing a new exercise, or increasing resistance you will be sore too. You should not be in pain, however and if your soreness is there for more than 1-2 days, speak up on your next PT session because that is too long.

Most of the time physical therapy should be comfortable and leave you feeling good!

Strengthening your hip abductors, hip external rotators and gluts will help prevent hip bursitis. This lady walks with a limp and pain because these muscles are weak.

When you walk with this kind of limp, the front hip flexors that twist the thigh in are tugging the iliotibial band forward, and straining the gluts.

The exercises you can perform to reduce the risk of hip bursitis is to stretch your tensor fascia latae, and strengthening your hip external rotators, hip abductors and hip extensors.

To stretch your tensor fascia latae, lay on your good side, pull your top foot to the buttocks, keeping the foot close to the floor; then put your good lower leg on top of the painful thigh and stretch. To strengthen your hip abductors, lay on your stomach and slide your leg out like a snow angel. Stop at 30. To strengthen your hip extensors lay on your stomach with a pillow under your waist. Bend up the lower leg and lift the thigh to the ceiling. Stop at 30.

Have you ever wondered if you should have an MRI? Did your health care provider tell you that you did not need one and you wondered why not?

I had a patient from Lacey with a shoulder bursitis ask me that question…and I told her "no" I didn't think she needed an MRI. She had come to me with horrible shoulder pain; on her first visit we simply treated her bad pain after performing a few safety tests to make sure these procedures were safe. On her first visit she could only lift her arm 3 inches, had to be driven to PT and had to have help getting dressed.

After a 3 or 4 visits, she had a lot less pain. She could drive herself, get dressed and lift her arm overhead. She still had pain rotating her lower arm out to the side and had some tingling and numbness. I evaluated her and told her I thought she had had a bursitis and possibly an infraspinatus (one of the 4 rotator cuff muscles) strain but not tear. She wanted to know if she should have an MRI, and I told her I did not think so….she wanted to know why not.

I walked her through the process of understanding how a physical therapist sees if a muscle is torn. I took a large theraband, and showed her how a torn or cut muscle cannot bring the two ends of the joint together if it is not attached in the middle. A physical therapist knows what directions a specific muscle moves the joint. Seeing a joint move the in direction of the muscle tells the physical therapist that the muscles is not torn; if it was torn the joint would not move. Once she had that explanation she understood why she did not need an MRI.

If you want to know why you don't need an MRI, take the time to ask your provider why not…so you can understand the process.